|
HC THORA KIT PLEURAL SEAL
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
900831718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Blue Shield of California Commercial |
$228.81
|
| Rate for Payer: Blue Shield of California EPN |
$149.18
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
|
|
HC THRCSCPY DGNSTC LUNGS WO BX
|
Facility
|
IP
|
$20,482.00
|
|
|
Service Code
|
CPT 32601
|
| Hospital Charge Code |
900831704
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,096.40 |
| Max. Negotiated Rate |
$18,433.80 |
| Rate for Payer: Adventist Health Commercial |
$4,096.40
|
| Rate for Payer: Cash Price |
$11,265.10
|
| Rate for Payer: Central Health Plan Commercial |
$16,385.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,192.80
|
| Rate for Payer: Galaxy Health WC |
$17,409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,433.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,661.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,803.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,678.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,096.40
|
| Rate for Payer: Multiplan Commercial |
$15,361.50
|
| Rate for Payer: Networks By Design Commercial |
$13,313.30
|
| Rate for Payer: Prime Health Services Commercial |
$17,409.70
|
|
|
HC THRCSCPY DGNSTC LUNGS WO BX
|
Facility
|
OP
|
$20,482.00
|
|
|
Service Code
|
CPT 32601
|
| Hospital Charge Code |
900831704
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.62 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$4,096.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,413.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,194.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,811.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$11,265.10
|
| Rate for Payer: Cash Price |
$11,265.10
|
| Rate for Payer: Cash Price |
$11,265.10
|
| Rate for Payer: Central Health Plan Commercial |
$16,385.60
|
| Rate for Payer: Cigna of CA HMO |
$13,108.48
|
| Rate for Payer: Cigna of CA PPO |
$15,156.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7,413.14
|
| Rate for Payer: Galaxy Health WC |
$17,409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,433.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,157.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$317.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: InnovAge PACE Commercial |
$11,119.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,661.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,413.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,096.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,933.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,933.61
|
| Rate for Payer: Multiplan Commercial |
$15,361.50
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Networks By Design Commercial |
$13,313.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Preferred Health Network WC |
$12,052.57
|
| Rate for Payer: Prime Health Services Commercial |
$17,409.70
|
| Rate for Payer: Prime Health Services Medicare |
$7,857.93
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Riverside University Health System MISP |
$8,154.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,413.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC THRCSCPY DGNSTC W BX OF PLEURA
|
Facility
|
OP
|
$20,482.00
|
|
|
Service Code
|
CPT 32609
|
| Hospital Charge Code |
900831705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$370.76 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$4,096.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,413.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,194.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,811.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$11,265.10
|
| Rate for Payer: Cash Price |
$11,265.10
|
| Rate for Payer: Cash Price |
$11,265.10
|
| Rate for Payer: Central Health Plan Commercial |
$16,385.60
|
| Rate for Payer: Cigna of CA HMO |
$13,108.48
|
| Rate for Payer: Cigna of CA PPO |
$15,156.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7,413.14
|
| Rate for Payer: Galaxy Health WC |
$17,409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,433.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,157.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$370.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: InnovAge PACE Commercial |
$11,119.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,661.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,413.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,096.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,933.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,933.61
|
| Rate for Payer: Multiplan Commercial |
$15,361.50
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Networks By Design Commercial |
$13,313.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Preferred Health Network WC |
$12,052.57
|
| Rate for Payer: Prime Health Services Commercial |
$17,409.70
|
| Rate for Payer: Prime Health Services Medicare |
$7,857.93
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Riverside University Health System MISP |
$8,154.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,413.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC THRCSCPY DGNSTC W BX OF PLEURA
|
Facility
|
IP
|
$20,482.00
|
|
|
Service Code
|
CPT 32609
|
| Hospital Charge Code |
900831705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,096.40 |
| Max. Negotiated Rate |
$18,433.80 |
| Rate for Payer: Adventist Health Commercial |
$4,096.40
|
| Rate for Payer: Cash Price |
$11,265.10
|
| Rate for Payer: Central Health Plan Commercial |
$16,385.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,192.80
|
| Rate for Payer: Galaxy Health WC |
$17,409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,433.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,661.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,803.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,678.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,096.40
|
| Rate for Payer: Multiplan Commercial |
$15,361.50
|
| Rate for Payer: Networks By Design Commercial |
$13,313.30
|
| Rate for Payer: Prime Health Services Commercial |
$17,409.70
|
|
|
HC THRCSCPY SX W PRTL PLMNRY DCRTCTN
|
Facility
|
IP
|
$27,088.00
|
|
|
Service Code
|
CPT 32651
|
| Hospital Charge Code |
909010014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,417.60 |
| Max. Negotiated Rate |
$24,379.20 |
| Rate for Payer: Adventist Health Commercial |
$5,417.60
|
| Rate for Payer: Cash Price |
$14,898.40
|
| Rate for Payer: Central Health Plan Commercial |
$21,670.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,835.20
|
| Rate for Payer: Galaxy Health WC |
$23,024.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,252.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,379.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,067.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,320.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,767.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,417.60
|
| Rate for Payer: Multiplan Commercial |
$20,316.00
|
| Rate for Payer: Networks By Design Commercial |
$17,607.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,024.80
|
|
|
HC THRCSCPY SX W PRTL PLMNRY DCRTCTN
|
Facility
|
OP
|
$27,088.00
|
|
|
Service Code
|
CPT 32651
|
| Hospital Charge Code |
909010014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$887.54 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,417.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,898.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,316.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$14,898.40
|
| Rate for Payer: Cash Price |
$14,898.40
|
| Rate for Payer: Cash Price |
$14,898.40
|
| Rate for Payer: Central Health Plan Commercial |
$21,670.40
|
| Rate for Payer: Cigna of CA HMO |
$17,336.32
|
| Rate for Payer: Cigna of CA PPO |
$20,045.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,024.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,024.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,835.20
|
| Rate for Payer: Galaxy Health WC |
$23,024.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,252.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,379.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$887.54
|
| Rate for Payer: InnovAge PACE Commercial |
$13,544.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,067.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$980.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,767.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,417.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,961.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,961.60
|
| Rate for Payer: Multiplan Commercial |
$20,316.00
|
| Rate for Payer: Networks By Design Commercial |
$17,607.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,024.80
|
| Rate for Payer: Riverside University Health System MISP |
$10,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,252.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,024.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23,024.80
|
|
|
HC THRCSCPY SX W RMVL IP FB OR FIBRIN DEP
|
Facility
|
OP
|
$27,088.00
|
|
|
Service Code
|
CPT 32653
|
| Hospital Charge Code |
909010015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$833.10 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$5,417.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,898.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,316.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$14,898.40
|
| Rate for Payer: Cash Price |
$14,898.40
|
| Rate for Payer: Cash Price |
$14,898.40
|
| Rate for Payer: Central Health Plan Commercial |
$21,670.40
|
| Rate for Payer: Cigna of CA HMO |
$17,336.32
|
| Rate for Payer: Cigna of CA PPO |
$20,045.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,024.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,024.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,835.20
|
| Rate for Payer: Galaxy Health WC |
$23,024.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,252.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,379.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$833.10
|
| Rate for Payer: InnovAge PACE Commercial |
$13,544.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,067.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$920.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,767.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,417.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,961.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,961.60
|
| Rate for Payer: Multiplan Commercial |
$20,316.00
|
| Rate for Payer: Networks By Design Commercial |
$17,607.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,024.80
|
| Rate for Payer: Riverside University Health System MISP |
$10,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,252.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,024.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23,024.80
|
|
|
HC THRCSCPY SX W RMVL IP FB OR FIBRIN DEP
|
Facility
|
IP
|
$27,088.00
|
|
|
Service Code
|
CPT 32653
|
| Hospital Charge Code |
909010015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,417.60 |
| Max. Negotiated Rate |
$24,379.20 |
| Rate for Payer: Adventist Health Commercial |
$5,417.60
|
| Rate for Payer: Cash Price |
$14,898.40
|
| Rate for Payer: Central Health Plan Commercial |
$21,670.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,835.20
|
| Rate for Payer: Galaxy Health WC |
$23,024.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,252.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,379.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,067.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,320.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,767.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,417.60
|
| Rate for Payer: Multiplan Commercial |
$20,316.00
|
| Rate for Payer: Networks By Design Commercial |
$17,607.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,024.80
|
|
|
HC THROMBECTOMY CATH, 6&7F HYDROL
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$792.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,080.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$797.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,113.12
|
| Rate for Payer: Blue Shield of California EPN |
$725.76
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,152.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,224.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,296.00
|
| Rate for Payer: InnovAge PACE Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,008.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: Riverside University Health System MISP |
$576.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,224.00
|
|
|
HC THROMBECTOMY CATH, 6&7F HYDROL
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,113.12
|
| Rate for Payer: Blue Shield of California EPN |
$725.76
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,152.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,296.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
900910021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
900910021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$42.07 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$19.42
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.79
|
| Rate for Payer: EPIC Health Plan Senior |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.77
|
| Rate for Payer: InnovAge PACE Commercial |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.73
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.77
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Prime Health Services Medicare |
$6.12
|
| Rate for Payer: Riverside University Health System MISP |
$6.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5.77
|
|
|
HC THROMBOELASTOGRAPH
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC THROMBOELASTOGRAPH
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$116.66 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.68
|
| Rate for Payer: Blue Shield of California Commercial |
$42.49
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.50
|
| Rate for Payer: InnovAge PACE Commercial |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.98
|
| Rate for Payer: United Healthcare All Other HMO |
$15.98
|
| Rate for Payer: United Healthcare HMO Rider |
$15.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
IP
|
$5,671.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
906820230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,134.20 |
| Max. Negotiated Rate |
$5,103.90 |
| Rate for Payer: Adventist Health Commercial |
$1,134.20
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,268.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,268.40
|
| Rate for Payer: Galaxy Health WC |
$4,820.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,402.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,103.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,782.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,160.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,510.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,134.20
|
| Rate for Payer: Multiplan Commercial |
$4,253.25
|
| Rate for Payer: Networks By Design Commercial |
$3,686.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,820.35
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
OP
|
$5,671.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
906820230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.80 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$1,134.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,442.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,251.39
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,536.80
|
| Rate for Payer: Cigna of CA HMO |
$3,629.44
|
| Rate for Payer: Cigna of CA PPO |
$4,196.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$4,820.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,402.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,103.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$564.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,782.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,134.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$4,253.25
|
| Rate for Payer: Networks By Design Commercial |
$3,686.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Prime Health Services Commercial |
$4,820.35
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,402.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,402.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,835.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,835.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,835.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,835.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
OP
|
$6,522.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
909020164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.80 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$1,304.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,958.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,589.23
|
| Rate for Payer: Cash Price |
$3,587.10
|
| Rate for Payer: Cash Price |
$3,587.10
|
| Rate for Payer: Cash Price |
$3,587.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,217.60
|
| Rate for Payer: Cigna of CA HMO |
$4,174.08
|
| Rate for Payer: Cigna of CA PPO |
$4,826.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$5,543.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,913.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,869.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$564.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,350.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,304.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$4,891.50
|
| Rate for Payer: Networks By Design Commercial |
$4,239.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Prime Health Services Commercial |
$5,543.70
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,913.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,913.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,261.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
IP
|
$6,522.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
909020164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,304.40 |
| Max. Negotiated Rate |
$5,869.80 |
| Rate for Payer: Adventist Health Commercial |
$1,304.40
|
| Rate for Payer: Cash Price |
$3,587.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,608.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,608.80
|
| Rate for Payer: Galaxy Health WC |
$5,543.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,913.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,869.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,350.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,484.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,037.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,304.40
|
| Rate for Payer: Multiplan Commercial |
$4,891.50
|
| Rate for Payer: Networks By Design Commercial |
$4,239.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,543.70
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
OP
|
$13,638.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
909020157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.56 |
| Max. Negotiated Rate |
$12,274.20 |
| Rate for Payer: Adventist Health Commercial |
$2,727.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,278.27
|
| Rate for Payer: Blue Shield of California EPN |
$5,414.29
|
| Rate for Payer: Cash Price |
$7,500.90
|
| Rate for Payer: Cash Price |
$7,500.90
|
| Rate for Payer: Cash Price |
$7,500.90
|
| Rate for Payer: Central Health Plan Commercial |
$10,910.40
|
| Rate for Payer: Cigna of CA HMO |
$8,728.32
|
| Rate for Payer: Cigna of CA PPO |
$10,092.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,592.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,182.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,274.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$205.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,727.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,228.50
|
| Rate for Payer: Networks By Design Commercial |
$8,864.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$11,592.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,182.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,182.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,819.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,819.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,819.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,819.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
IP
|
$11,859.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
906820227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,371.80 |
| Max. Negotiated Rate |
$10,673.10 |
| Rate for Payer: Adventist Health Commercial |
$2,371.80
|
| Rate for Payer: Cash Price |
$6,522.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,487.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,743.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,743.60
|
| Rate for Payer: Galaxy Health WC |
$10,080.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,115.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,673.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,909.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,518.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,340.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,371.80
|
| Rate for Payer: Multiplan Commercial |
$8,894.25
|
| Rate for Payer: Networks By Design Commercial |
$7,708.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,080.15
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
IP
|
$13,638.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
909020157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,727.60 |
| Max. Negotiated Rate |
$12,274.20 |
| Rate for Payer: Adventist Health Commercial |
$2,727.60
|
| Rate for Payer: Cash Price |
$7,500.90
|
| Rate for Payer: Central Health Plan Commercial |
$10,910.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,455.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,455.20
|
| Rate for Payer: Galaxy Health WC |
$11,592.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,182.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,274.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,196.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,441.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,727.60
|
| Rate for Payer: Multiplan Commercial |
$10,228.50
|
| Rate for Payer: Networks By Design Commercial |
$8,864.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,592.30
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
OP
|
$11,859.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
906820227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.56 |
| Max. Negotiated Rate |
$10,673.10 |
| Rate for Payer: Adventist Health Commercial |
$2,371.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,198.41
|
| Rate for Payer: Blue Shield of California EPN |
$4,708.02
|
| Rate for Payer: Cash Price |
$6,522.45
|
| Rate for Payer: Cash Price |
$6,522.45
|
| Rate for Payer: Cash Price |
$6,522.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,487.20
|
| Rate for Payer: Cigna of CA HMO |
$7,589.76
|
| Rate for Payer: Cigna of CA PPO |
$8,775.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$10,080.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,115.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,673.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$205.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,909.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,371.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,894.25
|
| Rate for Payer: Networks By Design Commercial |
$7,708.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$10,080.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,115.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,115.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,929.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,929.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,929.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,929.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906811110
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$244.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,037.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$671.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$915.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$591.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.09
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Central Health Plan Commercial |
$976.80
|
| Rate for Payer: Cigna of CA HMO |
$793.65
|
| Rate for Payer: Cigna of CA PPO |
$903.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,037.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,037.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.40
|
| Rate for Payer: EPIC Health Plan Senior |
$488.40
|
| Rate for Payer: Galaxy Health WC |
$1,037.85
|
| Rate for Payer: Global Benefits Group Commercial |
$732.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$579.28
|
| Rate for Payer: InnovAge PACE Commercial |
$610.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$814.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$639.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$755.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$854.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$854.70
|
| Rate for Payer: Multiplan Commercial |
$915.75
|
| Rate for Payer: Networks By Design Commercial |
$793.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.85
|
| Rate for Payer: Riverside University Health System MISP |
$488.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$732.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$732.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,037.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,037.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.85
|
|
|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906811110
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$1,098.90 |
| Rate for Payer: Adventist Health Commercial |
$244.20
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Central Health Plan Commercial |
$976.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.40
|
| Rate for Payer: EPIC Health Plan Senior |
$488.40
|
| Rate for Payer: Galaxy Health WC |
$1,037.85
|
| Rate for Payer: Global Benefits Group Commercial |
$732.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$814.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$755.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.20
|
| Rate for Payer: Multiplan Commercial |
$915.75
|
| Rate for Payer: Networks By Design Commercial |
$793.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.85
|
|
